Occlusive Device

ABSTRACT

An occlusive device comprising a braided component which can be inserted into a blood vessel and a delivery system for delivering said occlusive device is described.

RELATED APPLICATIONS

This application claims priority to U.S. Provisional Application Ser.No. 61/752,373 filed Jan. 14, 2013 entitled Occlusive Device, which ishereby incorporated herein by reference in its entirety.

BACKGROUND OF THE INVENTION

Occlusive devices, such as coils and plugs, are often used to treatvarious intravascular conditions such as arteriovenous malformation(AVM), aneurysm, fistula, atrial septal defect, patent foramen ovale,left atrial appendage, and other general blood vessel malformations.These devices occlude the cavity and limit blood flow to themalformation to reduce the chance of any bursting of the blood vessel.These devices must be able to effectively occlude all the space in orderto prevent blood flow into the vessel malformation, and allow themalformation to clot. The use of an occlusive device with a flexible,conforming shape would be beneficial in order to effectively fill thespace in a malformation.

SUMMARY OF THE INVENTION

An occlusive device and a delivery system for delivering said occlusivedevice is described.

Generally, the occlusive device has a distal portion configured toconform to an interior surface of a vascular malformation; and aproximal portion configured to substantially fill a remaining interiorvolume of the vascular malformation after the distal portion is deployedtherein.

In one embodiment the occlusive device is a straight tubular braid thatmakes up both the distal portion and the proximal portion.

In another embodiment the occlusive device is a linearly tapered tubularbraid.

In another embodiment the occlusive device is a step-tapered tubularbraid.

In another embodiment the occlusive device is a braid with a trumpetedshape at one end.

In another embodiment the occlusive device is a braid with a trumpetedshape at both ends.

In another embodiment the occlusive device is a braid with a variablepitch.

In another embodiment the occlusive device is a braided structureconnected to a coil-shaped structure such that the braided structuremakes up the distal portion and the coil-shaped structure makes up theproximal portion, or vice versa.

In another embodiment the occlusive device is a braid segmented byradiopaque markers to create a variable diameter shape.

In another embodiment the occlusive device is a braid which iselectropolished at various areas along its length to provide variablewall thickness.

In another embodiment the occlusive device is a braid connected to oneor more coils such that the braid makes up the distal portion and thecoils make up the proximal portion, or vice versa.

In another embodiment the occlusive device is a braid connected to oneor more embolic coils.

In one embodiment, a delivery system is provided that includes a sheathand a pusher slidably disposed within the sheath.

In one embodiment a delivery system for delivering an occlusive deviceincludes a core wire pusher.

In another embodiment a delivery system for delivering an occlusivedevice includes an elastic pusher.

In another embodiment a delivery system for delivering an occlusivedevice includes a hypotube pusher.

In one embodiment an occlusive device is connected to a pusher and saidocclusive device is delivered in a linear configuration.

In another embodiment an occlusive device is connected to a pusher andsaid occlusive device is delivered in an inverted configuration.

In another embodiment an occlusive device is connected to a pusher atmultiple points along said pusher and said occlusive device is deliveredin an inverted configuration.

In another embodiment an occlusive device is connected to a pusher atmultiple points along said pusher and said occlusive device is deliveredin a linear configuration.

One aspect of the invention is a method of occluding a vascularmalformation including pushing a distal portion of an occlusive devicethrough a distal end of a delivery device into a vascular malformation,allowing the distal portion to expand and adapt to a shape of thevascular malformation, and pushing a proximal portion of the occlusivedevice through the distal end of said delivery device into a spaceremaining within said distal portion to fill a remaining space insidesaid vascular malformation.

BRIEF DESCRIPTION OF THE DRAWINGS

These and other aspects, features and advantages of the invention willbe apparent and elucidated from the following description of embodimentsof the present invention, reference being made to the accompanyingdrawings, in which:

FIG. 1 illustrates a straight tubular braided occlusive device.

FIGS. 2-3 illustrate braid angles on a braided occlusive device.

FIG. 4 illustrates a cross section of a linearly tapered braidedocclusive device.

FIG. 5 illustrates a cross section of a step tapered braided occlusivedevice.

FIG. 6 illustrates a braided occlusive device with a trumpeted shape atone end.

FIG. 7 illustrates a braided occlusive device with a trumpeted shape atboth ends.

FIG. 8 illustrates a cross section of a braided occlusive device with avariable pitch.

FIG. 9 illustrates an occlusive device comprising a braided structureconnected to a coil shaped structure.

FIG. 10 illustrates a cross section of a braided occlusive devicesegmented by radiopaque markers.

FIG. 11 illustrates a cross section of a braided occlusive device whichis electropolished at various areas along its length to provide variablewall thickness.

FIG. 12 illustrates a straight tubular braided occlusive device whichmay be deployed in an aneurysm model.

FIG. 13 illustrates the occlusive device of FIG. 12 folded in uponitself during deployment.

FIG. 14-21 illustrate the deployment of the occlusive device of FIG. 12in an aneurysm model.

FIG. 22 illustrates two occlusive devices deployed in an aneurysm model.

FIG. 23 illustrates an occlusive device utilizing a distal tubular andproximal coil structure in an aneurysm model.

FIGS. 24-25 illustrate an braided occlusive device connected to a coil.

FIGS. 26-28 illustrate a braided occlusive device delivered in aninverted configuration.

FIGS. 29-32 illustrate various delivery configurations for a braidedocclusive device.

DESCRIPTION OF EMBODIMENTS

Specific embodiments of the invention will now be described withreference to the accompanying drawings. This invention may, however, beembodied in many different forms and should not be construed as limitedto the embodiments set forth herein; rather, these embodiments areprovided so that this disclosure will be thorough and complete, and willfully convey the scope of the invention to those skilled in the art. Theterminology used in the detailed description of the embodimentsillustrated in the accompanying drawings is not intended to be limitingof the invention. In the drawings, like numbers refer to like elements.

Unless otherwise defined, all terms (including technical and scientificterms) used herein have the same meaning as commonly understood by oneof ordinary skill in the art to which this invention belongs. It will befurther understood that terms, such as those defined in commonly useddictionaries, should be interpreted as having a meaning that isconsistent with their meaning in the context of the relevant art andwill not be interpreted in an idealized or overly formal sense unlessexpressly so defined herein.

The term aneurysm may be used to describe a particular vesselabnormality or malformation, however, this term is not meant to beoverly limiting to solely aneurysms. The device described may be used totreat—for example—aneurysms, fistulas, septal defects, left atrialappendages, arteriovenous malformations, patent foramen ovale, and othergeneral vessel malformations and should be construed as being applied toa general swath of blood vessel malformations which may occur within thevascular system.

The various occlusive devices described herein generally have a distalportion and a proximal portion. The distal portion is deemed to be thatportion of the device that is delivered first and conforms to aninterior surface of the vascular malformation. The proximal portion isdeemed to be that portion of the device that is delivered after thedistal portion has been delivered.

The distinction between the distal portion and the proximal portions,for many embodiments, will be determined by the size and shape of thetargeted malformation. For example, in the case of a tubular braideddevice, the device will tend to expand radially until the walls of thedevice come into contact with the walls of the malformation, additionalmaterial delivered to the malformation will cause a fold near theopening of the malformation and the additional braided material willfold itself into the distal portion of the braid that is in contact withthe walls of the malformation.

In other embodiments, which feature two different structures, the distaland proximal portions may be distinguished by the structures themselves.For example, in the case of a tubular braid connected to a coil, thebraid may represent the distal portion and the coil may represent theproximal portion, or vice versa. Understanding this convention, as usedthroughout the specification and claims, attention may now be given tothe following description of the various embodiments.

An occlusive device 10 is shown in FIG. 1. The occlusive device shown isa tubular braid. The wires comprising the braid have a circular crosssection, although different cross sectional shapes (i.e. elliptical,semi-circular, rectangular, etc.) could also be used. The braid itselfmay have a circular cross section, although different cross sectionalshapes (i.e. elliptical, semi-circular, rectangular, etc.) could also beused. Radiopaque material such as tantalum or platinum could also beused to aid imaging. In one example the device is made entirely fromnitinol wires. In another example the device is a combination of nitinoland platinum wires. In another example the braid is a combination ofnitinol and tantalum wires. In another example the device is made ofcobalt chromium wires. In another example, various combinations thereinof nitinol, platinum or tantalum, and cobalt chromium wires are used inthe device. The device can be braided from the wire materialcombinations listed above where the diameter range of the wires isbetween 0.0005″-0.003″. The number of wires used in the braid can rangefrom 30-500. In one example, 96-192 wires are used in the braid. Thebraid angle can be between 30-150 degrees. In one example a braid anglebetween 68-143 degrees may be used. FIG. 2 shows an obtuse braid angleconfiguration while FIG. 3 shows an acute braid angle configuration.These configurations would be how the braid sits when proceedinglongitudinally along the length of the occlusive device (i.e.left-to-right or right-to-left in FIG. 1). The braided occlusive deviceis highly adaptable in space-filling applications thus promoting foldingand adaptability when deployed within an aneurysm or vesselmalformation. This adaptability is due to a combination of factorsincluding the softness of the wires used to create the braid, the ratioof wire diameter to overall braid diameter, the braid angle used, andthe shape of the occlusive device. Polymer microfibers may be includedwithin the combination of materials used in the occlusive device.Alternatively, polymer microfibers may be used alone to make theocclusive device. A biodegradable material may also be used alone, oramong the combination of material used in the braid. In one example, thebraid is made of three different types of wire. In such an example, themajority of the braid can be made of small diameter wire (i.e. between0.0005″-0.002″) to promote shape retention and adaptability of thebraid. Tantalum wires can also be used periodically at places within thebraid to promote visibility, with the added benefit that as the braidfolds inwards during space-filling, the visibility will only bemultiplied as the tantalum-containing portions get packed closertogether. Larger diameter wires can sit on the outside of the braid,similar to a rail system where these larger wires contact the deliverydevice (i.e. microcatheter) during deployment, and contact the vesselwall when deployed. Since these larger wires will contact the innersurface of the microcatheter, the rest of the braid (comprising smallerwires) glides making deployment easier by reducing overall frictionduring delivery. Similarly, these larger wires promote expansion whendeployed and create varied profile regions which the smaller braid wireportions can subsequently fill. The braid can also include hydrogel.Hydrogel generally expands on contact with a certain ph substance, suchas blood, and is typically used in embolic materials such as coils. Thehydrogel can be placed on the interior and/or exterior of the braid.When placed on the exterior of the braid it can fill some of the spacebetween the braid and vessel wall. When placed within the braid it canfill some of the interior space, especially once the braid folds inwardupon itself, and help maximize the space filling potential of the braid.Though various measurements are offered by way of examples to describethe braid, these measurements are not meant to limit the scope of theinvention and are instead offered as examples.

Additional occlusive device embodiments utilize different shapes asidefrom the tubular braid configuration shown in FIG. 1. These embodimentsare shown in FIGS. 4-11.

One embodiment shown in FIG. 4 utilizes a linearly tapered tubularbraid, where the braid diameter tapers in a linear manner from eitherthe proximal to distal end of the braid, or vice-versa.

Another embodiment shown in FIG. 5 utilizes a step-tapered profile shapewhere the braid tapers from a smaller diameter to a larger diameter in astep-wise manner. Different shapes can be used to create thestep-tapered shape between the smaller and larger diameter regions, suchas rectangular, elliptical, etc.

Another embodiment shown in FIG. 6 has an enlarged, trumpeted shape 12at either the proximal or distal end of the occlusive device.

Another embodiment shown in FIG. 7 has an enlarged, trumpeted shape 12at both the proximal and distal ends of the occlusive device.

Another embodiment shown in FIG. 8 has a variable pitch profile. Thoughthe figure shows alternating enlarged pitch regions 14, otherpossibilities may include a smaller pitch followed by a larger pitch, alarger pitch followed by a smaller pitch, multiple smaller pitch regionsfollowed by one or more larger pitch regions, multiple larger pitchregions followed by one or more smaller pitch regions, or variouscombinations of smaller pitch/larger pitch regions used to create avariable pitch profile through the length of the occlusive device.

Another embodiment shown in FIG. 9 is an occlusive device comprising atubular braided member 10 (similar to the tubular braided member ofFIG. 1) connected to a coiled member 16. In one example of thisembodiment, the distal component of the occlusive device (which is thefirst component inserted into the malformation or aneurysm) is tubularand the more proximal component is coiled. This allows the distalcomponent to adapt to the dome of the aneurysm or vessel malformation,and the proximal component to coil to fill the space of themalformation. The braided member may not necessarily be tubular and canadopt one or more of the shapes shown in the other various embodimentsdescribed.

Another embodiment shown in FIG. 10 is an occlusive device utilizingcrimped radiopaque marker bands 18. Marker bands 18 are crimped alongparticular regions of the occlusive device to create smaller diameterregions to vary the shape of the occlusive device. The marker bands alsoallow for enhanced imaging of the device during deployment due to theradiopaque material quality. The marker bands may have variable spacingto change the folding and adaptability of the occlusive device as it isdeployed in the aneurysm or malformation.

Another embodiment shown in FIG. 11 is an occlusive device utilizingelectropolished regions. Certain regions of the occlusive device areelectropolished to create smaller wall thickness regions 20 to optimizefolding, inverting and shape retention of the braid inside the aneurysmor malformation. In one example, a distal portion of the occlusivedevice is selectively electropolished along particular regions toincrease the folding, inverting, and shape retention of the braidedocclusive device within the dome of the aneurysm or malformation. Inthis particular example the more proximal portion of the device does notutilize eletropolishing, and thus has a larger wall thickness to promotemore uniform space filling at the base of the aneurysm or malformation.

FIG. 12 shows a tubular braid occlusive device similar to the embodimentshown in FIG. 1. The occlusive device is highly conformable andadaptable in shape. FIG. 13 shows the tubular braid occlusive device 10delivered through a delivery device (i.e. a microcatheter) 22. As shownin FIG. 13, the device can fold in upon itself due to the shape andmaterial properties of the tubular braid.

FIG. 14 shows an aneurysm model 24 with a delivery device 22 used todeliver the occlusive device within aneurysm model 24. The occlusivedevice 10 is pushed through the distal end of delivery device 22 andinitially adopts a contracted state similar to the diameter of thedelivery device 22, as shown in FIG. 15. Eventually the occlusive devicestarts adapting to the shape of the aneurysm as shown in FIGS. 16-18.Due to the shape adaptability of the braid used to create the occlusivedevice, the device will then start folding in on itself, thus maximizingits space filling potential, as shown in FIGS. 19-20. Once the braidfolds in upon itself to fill the empty portion within the deployedbraid, it will then expand to fill the rest of the aneurysm, as shown inFIG. 21.

FIG. 22 shows two sequentially deployed occlusive devices 10 a and 10 bwhich can be used to form to fill an aneurysm model. The occlusivedevices 10 a and 10 b may separately be deployed one after the other, orthe two occlusive devices may be connected together to create anextended length occlusive device 10. In either case the device 10 adelivered first is considered the distal portion and the devicedelivered second 10 b is considered the proximal portion. An arrangementinvolving multiple occlusive devices may be useful in a particularlylarge aneurysm or malformation.

FIG. 23 shows the device of FIG. 9 deployed in an aneurysm model 24. Theocclusive device has a distal portion that is a tubular braid component10 and a proximal portion that is a connected coiled component 16.Another example may utilize a tubular braid component 10 and aseparately deployed coiled component 16. Another example may utilize abraid component of a non-tubular shape (i.e. the shapes in FIG. 4-8, 10or 11) and a coiled component 16. In this figure the braid component 10sits distal to the coiled component 16 and is deployed first within theaneurysm. The braid adapts to the shape of the aneurysm dome and foldsin upon itself to maximize space filling, as highlighted earlier inFIGS. 15-20. The coiled component 16 then fills in the base of theaneurysm or malformation. Another example may utilize a distal coiledcomponent and a proximal braid component. Another example may utilizeone or more braid components separated by one or more coiled components.

In another embodiment shown in FIGS. 24-25 the braided occlusive device10 may be attached to one or more coils 26. As indicated in FIG. 24, thebraid may be packed into one end of the coil. Alternatively, one or morecoils may be attached around the periphery of the braided occlusivedevice. Alternatively, one or more coils may be attached within thebraided occlusive device, as shown in FIG. 25. In one example, the oneor more coils are attached to the distal end of the braided occlusivedevice, such that the coil is deployed first. When used to fill amalformation such as aneurysm, the coil will create a boundary aroundthe dome of the aneurysm which the braid will subsequently fill.

In another embodiment the braided occlusive device is connected to oneor more coils, where said coils are embolic coils. The coils 26 shown inFIGS. 24-25 may be embolic coils. Embolic coils are often used to treatvascular malformations such as aneurysms by filling the malformation. Inone example, the one or more embolic coils are attached to the distalend of the braided occlusive device, such that the coil is deployedfirst. When used to fill a malformation such as aneurysm, the coil willcreate a boundary around the dome of the aneurysm which the braid willsubsequently fill.

The braided occlusive device can be used with other embolic material aswell to fill aneurysms or other vascular malformations. For example, abraided occlusive device can initially be deployed to conform to theshape of the aneurysm while a hydrogel is subsequently deployed to fillthe space within the aneurysm. Alternatively, one or more embolic coilscan initially be implanted and a braided occlusive device issubsequently implanted to fill the aneurysm. Alternatively still, abraided occlusive device is initially implanted and one or more emboliccoils are subsequently implanted to fill the aneurysm. In one example,the one or more embolic coils can utilize hydrogel. Various combinationsof the occlusive device, embolic agents (such as coils, liquid embolic,plugs, etc) and hydrogel are feasible as well.

The delivery system for the occlusive device comprises a pusher 28 whichis connected to a portion of the occlusive device. In one embodimentpusher 28 is a metallic core wire. The core wire has a combination ofhigh tensile strength and flexibility to aid in trackability. The corewire could be a solid shaft, a coil, or a braided wire. It can beradiopaque or may include radiopaque components in order to aid inimaging during deployment. In one example, the core wire is a coil orshaft between 0.003-0.006″ outer diameter and is made of tantalum orplatinum. The coil or micro-coil wound configuration of the core wirewould allow for more flexibility versus the more rigid shaft which wouldhave higher tensile strength. An example of the coil is nitinol and/orstainless steel material coil spring. Another example is tantalum and/orplatinum coil spring. An example of the braided wire or microbraidincludes three platinum or tantalum wires of 0.0005″-0.002″ diameterwound together. Another example includes three nitinol or stainlesssteel wires of 0.0005″-0.0002″ diameter wound together. Nitinol and/orstainless could be used with tantalum and/or platinum to promotevisualization. Though various measurements are offered by way ofexamples to describe the pusher, these measurements are not meant tolimit the scope of the invention and are instead offered as examples.

In another embodiment pusher 28 is an elastic member. The elastic may beformed of a polymer, such as polyblend or other elastic polymers, andmay include radiopaque material to aid in imaging.

The pusher could also be a combination of an elastic and metallicmaterial.

Detachment means could be incorporated on the proximal and/or distalportion of the pusher, depending on where the pusher mates with thebraid. Examples include electrolytic, thermal, or mechanical detachmentmeans. One such thermal detachment that could be used is shown in U.S.Pat. No. 8,182,506 and U.S.20060200192, which are hereby incorporated byreference in their entirety.

An elastic, spring, or stretch-resistant element—such as Engage®, apolymer made by Dow Chemical, could be attached to the distal and/orproximal end of the pusher. The utilization of such an element would beespecially useful for a thermal detachment design where a polymericmaterial could be severed when a sufficient temperature is reached. Inone example this element acts as a detachment junction, which can bedegraded, severed, or mechanically manipulated to detach the occlusivedevice from the pusher.

The distal end of the pusher can be attached to the braid by a fusedpolymeric Material—such as an Engage—acting as an intermediary betweenthe pusher and braid. The fused polymer can be disengaged byelectrolytic or thermal means. Alternatively, the distal end of thepusher can be crimped into a radiopaque (i.e. platinum) marker andelectrolytic detachment can be used at a point proximal or distal ofthis marker. Alternatively, a mechanical screw detachment system may beused where the distal end of the pusher physically screws into, and outof, a corresponding receiving member on the braid. Alternatively, athermal detachment system can be used where the pusher/braid junctionutilizes a material that can be thermally disintegrated to initiatedetachment.

Another electrolytic detachment system utilizes a wire (i.e. one made ofstainless steel) running under a platinum or tantalum shaft or coil. Thestainless steel underwire can be electrolytically degraded to separatethe braid and the pusher.

In another embodiment pusher 28 is a hypotube. The hypotube may beformed of a metallic material (such as nitinol and/or stainless steel),radiopaque material (such as palladium and/or tantalum), a polymer, orcombinations therein. Occlusive device 10 is attached at the distal endof the hypotube, and may be connected to the hypotube by a detachmentjunction which is severed or manipulated to affect separation betweenthe hypotube and occlusive device. A stylet may be included within thehypotube to provide greater column strength to the hypotube, especiallyduring tracking through the delivery device (i.e. microcatheter) andvasculature. This stylet may be removable. In one example the hypotubeis delivered through the delivery device (i.e. microcatheter) to aparticular site within the vasculature. The stylet is subsequentlyremoved by retracting the proximal end of said stylet. The hypotube maybe formed of nitinol or stainless steel, and may include radiopaqueagents (such as tantalum or palladium) to aid in imaging. The distal endof the hypotube may utilize a coil to aid in flexibility of the distalend of the hypotube. A polymer (i.e. PTFE or Teflon) may be used as aninterior liner through the distal coiled portion of the hypotube toprevent leaks of any substances that may be delivered through thehypotube.

In one example hypotube pusher 28 is used to deliver occlusive device 10to a particular region within the vasculature. Following detachment ofthe occlusive device, the hypotube is subsequently used to deliverfurther embolic agents (i.e. embolic coils, liquid embolic, hydrogel).In the example of an aneurysm, occlusive device 10 would be used toconform to the general shape and fill some of the aneurysm while theadditional embolic agents delivered through the hypotube pusher wouldfill the remaining portion of the aneurysm. Since the hypotube isalready within the delivery device (i.e. microcatheter), delivery timewould be significantly reduced since one could use the hypotube todeliver additional agents instead of removing the hypotube completelyand using the microcatheter for further embolic agent delivery.

Multiple occlusive device delivery configuration embodiments arecontemplated. In one embodiment shown in FIG. 29, a pusher 28 isattached to the proximal end of the occlusive device 10, and theocclusive device is positioned and delivered linearly (i.e. saidocclusive device is not substantially inverted or flipped). A detachmentjunction 30 may be present where thermal, electrolytic, or mechanicalmeans may be utilized to sever the pusher from the occlusive device.

In another embodiment shown in FIG. 30, the pusher is attached to aportion of the occlusive device 10, and the occlusive device is foldedor inverted around the pusher within the delivery device. A detachmentjunction 30 may be present where thermal, electrolytic, or mechanicalmeans may be utilized to sever the pusher from the occlusive device.

In another embodiment shown in FIG. 31 the occlusive device is connectedto the pusher at a proximal and distal location. In another embodimentshown in FIG. 32, the pusher is attached to a portion of the braid andthe braid is folded or inverted around the core wire and connected tothe core wire at another, more proximal location. A detachment junction30 can be included at the more proximal location, the more distallocation, or both locations to sever the occlusive device 10 from thepusher 28. These embodiments would be particularly useful for theelastic pusher or spring core wire pusher concepts where the tension ofthe wire could be helpful in aiding adaptability of the braid bytransferring the stored tension to the braid during placement of saidbraid. The elastic or spring pusher could be pulled into tension whenplaced in the delivery device (i.e. microcatheter). The reduced innerdiameter of the delivery device keeps the occlusive device in a reducedprofile state, thus retaining the tension on the pusher. As theocclusive device is released from the delivery device and placed in thevessel, the occlusive device adopts its expanded configuration and thetension is transferred from the pusher to the braid as the braidencounters an opposing force (i.e. from the aneurysm dome wall, or theblood vessel wall). This tension transfer aids in the folding of thecompliant occlusive device, thus aiding its adaptability within thevessel, aneurysm or malformation. In one example, the detachmentjunction is located on the more proximal location of the pusher,resulting in a more distal portion of the pusher being severed duringdetachment. The more distal elastic pusher component when detached couldsubsequently remain within the vessel as another space filling material,along with the braid.

Though FIGS. 29-32 show one or two detachment junctions, more junctionsmay be utilized.

In one example shown in FIGS. 26-28, the folded or inverted shape of theocclusive device 10 about pusher 28 results in a fountain-like shape atthe distal end of occlusive device 10. The figures show the occlusivedevice when in a deployed (i.e. outside of delivery device 22) shape.FIG. 28 shows the occlusive device within an aneurysm model 24. Wherethe braid is used to fill an aneurysm, the portion of the braidcontacting the dome of the aneurysm will have the structural support ofthe pusher immediately behind, thus promoting a higher engaging forcebetween the braid and the dome wall, resulting in a better retentionforce between the braid and aneurysm wall. The bulbous portion of thefountain shape engages the aneurysm wall while the in-folded portion(see FIGS. 26-28) connected to the pusher allows an easier fill path forsubsequent portions of the braid as they are delivered from the deliverydevice. In one example, certain wires at the distal portion of the braidare heat treated to augment this fountain shape. The braid firstconforms to the shape of the aneurysm while subsequent portions of thebraid pack the interior of the aneurysm.

What is claimed is:
 1. A device for filling and occluding a vascularmalformation comprising: a distal portion configured to conform to aninterior surface of a vascular malformation; and, a proximal portionconfigured to substantially fill a remaining interior volume of thevascular malformation after said distal portion is deployed therein;wherein at least one of said distal portion and said proximal portion isa tubular braid.
 2. The device of claim 1 wherein said tubular braidcomprises wires braided to form a braid angle of between 30 and 150degrees.
 3. The device of claim 2 wherein said tubular braid compriseswires braided to form a braid angle of between 68 and 143 degrees. 4.The device of claim 1 wherein said tubular braid comprises a pluralityof wires.
 5. The device of claim 4 wherein said tubular braid furthercomprises hydrogel.
 6. The device of claim 1 wherein said tubular braidcomprises a shape selected from the group consisting of cylinder,linearly tapered, step-tapered, rectangular, elliptical, trumpeted,fountain, bulbous, and variable pitch.
 7. The device of claim 1 whereinone of said distal portion and said proximal portion comprises at leastone coil.
 8. The device of claim 1 further comprising electropolishedregions.
 9. The device of claim 1 wherein said tubular braid comprises ashape and material selected to fold in upon itself when delivered intothe vascular malformation.
 10. A method of occluding a vascularmalformation comprising: pushing a distal portion of an occlusive devicethrough a distal end of a delivery device into a vascular malformation;allowing said distal portion to expand and adapt to a shape of thevascular malformation; pushing a proximal portion of said occlusivedevice through said distal end of said delivery device into a spaceremaining within said distal portion to fill a remaining space insidesaid vascular malformation.
 11. The method of claim 10 wherein pushing aproximal portion of said occlusive device comprises pushing a proximalportion of said occlusive device that is unattached to said distalportion.
 12. The method of claim 10 wherein pushing a proximal portionof said occlusive device comprises pushing a proximal portion of saidocclusive device that is attached to said distal portion.
 13. The methodof claim 10 wherein pushing a distal portion of an occlusive devicethrough a distal end of a delivery device into a vascular malformationcomprises pushing a tubular braid through a distal end of a deliverydevice and wherein allowing said distal portion to expand and adapt to ashape of the vascular malformation comprises allowing said tubular braidto expand to radially to conform to an inside surface of the vascularmalformation.
 14. The method of claim 13 wherein pushing a proximalportion of said occlusive device through said distal end of saiddelivery device into a space remaining within said distal portion tofill a remaining space inside said vascular malformation comprisespushing a tubular braid that folds to fill a remaining space inside saidvascular malformation.
 15. The method of claim 13 wherein pushing aproximal portion of said occlusive device through said distal end ofsaid delivery device into a space remaining within said distal portionto fill a remaining space inside said vascular malformation comprisespushing at least one coil through said distal end of said deliverydevice to fill a remaining space inside said vascular malformation. 16.The method of claim 10 wherein pushing a distal portion of an occlusivedevice through a distal end of a delivery device into a vascularmalformation comprises pushing at least one coil through a distal end ofa delivery device and wherein allowing said distal portion to expand andadapt to a shape of the vascular malformation comprises allowing saidcoil to coil itself around an inside surface of the vascularmalformation.
 17. The method of claim 14 wherein pushing a proximalportion of said occlusive device through said distal end of saiddelivery device into a space remaining within said distal portion tofill a remaining space inside said vascular malformation comprisespushing a tubular braid that folds to fill a remaining space inside saidvascular malformation.
 18. The method of claim 14 wherein pushing aproximal portion of said occlusive device through said distal end ofsaid delivery device into a space remaining within said distal portionto fill a remaining space inside said vascular malformation comprisespushing at least one coil through said distal end of said deliverydevice to fill a remaining space inside said vascular malformation. 19.An apparatus for occluding a vascular malformation comprising: adelivery system including: a sheath; a pusher slidably disposed withinsaid sheath; an implant carried by said delivery system, said implantincluding: a distal portion configured to conform to an interior surfaceof a vascular malformation; and, a proximal portion configured tosubstantially fill a remaining interior volume of the vascularmalformation after said distal portion is deployed therein; wherein atleast one of said distal portion and said proximal portion is a tubularbraid.
 20. The apparatus of claim 19 wherein one of said distal portionand said proximal portion comprises at least one coil.
 21. The apparatusof claim 19 wherein said tubular braid comprises a shape and materialselected to fold in upon itself when delivered into the vascularmalformation.
 22. The apparatus of claim 19 wherein said pushercomprises a core wire.
 23. The apparatus of claim 19 wherein said pushercomprises an elastic member.
 24. The apparatus of claim 19 wherein saiddelivery system further comprises a detachment mechanism.
 25. Theapparatus of claim 19 wherein said pusher comprises a hypotube andwherein said apparatus further comprises an embolic agent deliverable tosaid vascular malformation through said hypotube.
 26. The apparatus ofclaim 19 wherein said implant comprises a fountain shape.